Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Gastrointest Endosc. 2010 Feb;71(2):402-6. doi: 10.1016/j.gie.2009.10.037.
PEG/jejunostomy (PEG/J) is often placed in patients with metastatic gastric cancer for palliating bowel obstruction or for feeding. However, PEG/J placement may not always be possible for many reasons.
We wish to bring attention to the percutaneous transesophageal gastrostomy/jejunostomy (PTEG/J) as a viable alternative to nasogastric decompression in patients who are not candidates for PEG/J. PTEG/J is a largely unknown technique in the United States that designed to gain access to the stomach and proximal small bowel in these patients. We describe the use of PTEG/J in 3 patients with metastatic gastric cancer by using resources and techniques readily available in a well-stocked interventional radiology suite.
In the first case, percutaneous transesophageal gastrostomy (PTEG) was placed for palliation of intractable nausea and vomiting in a 37-year-woman with diffuse gastric cancer and peritoneal carcinomatosis. In the second case, PTEG was extended into the jejunum for feeding a 60-year-old woman with metastatic gastric cancer. In the third case, PTEG extending into the jejunum was placed in a 69-year-old man for palliation of bowel obstruction caused by metastatic gastric cancer and peritoneal carcinomatosis.
After adequate sedation is administered, a 22 x 4-mm balloon catheter is passed into the esophagus over a guidewire just below the thoracic inlet. The balloon is ruptured with a needle passed through the neck under US guidance. A guidewire is then passed through the needle into the balloon and carried into the stomach or proximal small bowel by advancing the balloon catheter. The track is then dilated over the guidewire and a pigtail 45-cm-long 14F nephrostomy tube then passed into the stomach or into the proximal small bowel over the guidewire. The catheter is secured by suturing to the skin of the neck.
PTEG/J was effective in achieving palliation or feeding in our patients. No complications occurred.
PTEG/J is a safe and effective alternative to standard percutaneous gastrostomy/jejunostomy tube placement for decompression of bowel obstruction or feeding in appropriately selected patients.
PEG/空肠造口术（PEG/J）常用于缓解转移性胃癌患者的肠梗阻或提供营养支持。然而，由于多种原因，并非所有患者都适合进行 PEG/J 置管。
我们希望引起关注，即经皮经食管胃造口术/空肠造口术（PTEG/J）可作为 PEG/J 置管术的替代方法，用于不适合 PEG/J 置管术的患者。在美国，PTEG/J 是一种鲜为人知的技术，旨在为这些患者提供进入胃和近端小肠的途径。我们使用介入放射学设备中易于获取的资源和技术，描述了 3 例转移性胃癌患者中 PTEG/J 的应用。
在第一个病例中，为缓解弥漫性胃癌伴腹膜转移的 37 岁女性顽固性恶心和呕吐，进行了经皮经食管胃造口术（PTEG）。在第二个病例中，为 60 岁的转移性胃癌女性提供营养支持，将 PTEG 延长至空肠。在第三个病例中，为缓解转移性胃癌和腹膜转移引起的肠梗阻，为 69 岁男性进行了 PTEG 延长至空肠造口术。
在充分镇静后，将 22 x 4mm 球囊导管经导丝穿过食管，导丝位于胸入口下方。在超声引导下，通过穿过颈部的针将球囊破裂。然后，将导丝穿过针进入球囊，并通过推进球囊导管将其带入胃或近端空肠。然后，沿导丝扩张通道，并将一条 45cm 长的猪尾 14F 肾造瘘管经导丝放入胃或近端空肠。将导管通过缝合固定于颈部皮肤。
PTEG/J 对我们的患者有效，可实现缓解症状或提供营养支持。未发生并发症。
在适当选择的患者中，PTEG/J 是标准经皮胃造口术/空肠造口术置管术治疗肠梗阻或提供营养支持的安全有效替代方法。
